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Clinical Psych > Clinical Psych Midterm (1/25/25) > Flashcards

Clinical Psych Midterm (1/25/25) Flashcards

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1
Q

what is clinical psych

A
  • integration
  • application
  • reducing maladaptation and distress
  • increasing positive adaptation
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2
Q

types of assessments

A
  • intellectual batteries = IQ testing
  • eduction focus = achievement, behavior
  • neuropsychology = memory, language, functioning, behavior/emotional etc
  • personality = formal inventories, projectivies
  • interviewing
  • observation
  • forensic = testify
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3
Q

formal diagnosis

A
  • DSM-5/ ICD
  • assessment usually results in diagnosis
  • formal = number/title for billing purposes
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4
Q

eclectic

A
  • using more than one theory as a psychotherapist
  • different theories for different clients: biology, development, contextual factors
  • benefits: individualized therapy
  • concerns: jack of all trades, master of none
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5
Q

boating accident example

A

good qualities:
- calm and present
- asking questions
- validated the client’s feelings
- self-corrected based on what the client wants/needs

bad qualities:
- yelling/harsh
- not the right fit/vibe

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6
Q

anorexia video example

A

bad qualities:
- calling everything stupid
- harsh
- not adapting/self-correcting when she was talking about how serious her disorder is

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7
Q

19th century origins: empirical research

A
  • Wundt in Germany
  • Witmer in US: first applications to assessing and treating children for learning
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8
Q

19th century origins: psychometric testing

A
  • Cattell/Galton and Binet
  • goal of testing: sorting people into categories
  • originally meant to keep those at the top at the top (white supremacy)
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9
Q

19th century origins: psychotherapy

A
  • religious/supernatural explanations for psychosis
  • medical models (4 humors, head shape)
  • Charcot, Janet, Freud
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10
Q

early 20th century: assessment and war

A
  • assessing soldiers’ mental capacity during WWII - intellectual tests
  • development of personality assessments
  • broad expansion of measures
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11
Q

early 20th century: advancements in psychotherapy

A
  • psychoanalysis was dominated by psychiatry and med schools
  • psychologists were brought in to help with treatment post-war
  • development of work sites for psychologists: VA, community health clinics
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12
Q

history of the APA

A
  • originally for research psychologists
  • some advocated for applying psych to help people
  • others thought it would reduce scientific credibility
  • was formally recognized post-WWII but no formal training for licensure for clinical psychologists yet
  • 1940s: established procedures for training and certification
  • 1949: Boulder meeting for training model
  • 1953: first ethical guidelines
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13
Q

theories of intervention: how do they differ

A
  • assumptions about human nature
  • origins of mental health issues: family dynamics, environment, genetics
  • nature of the problem
  • role of insight: how much it matters if the client knows/understands where form or why they have issues
  • nature of therapeutic relationship: therapists as a real person, expert or guide/partner
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14
Q

theories of intervention: psychodynamic approach

A
  • negative view on human nature
  • negotiate conflicts between id (devil) and superego (angel)
  • ego is the mediator (self)
  • people are not fully aware of themselves
  • symptoms arise when unconscious conflicts are repressed (avoided): trauma/childhood events or relationship sequences
  • insight is key to treatment: become aware of conflicts so ego can be freed from the past
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15
Q

theories of intervention: humanistic approach

A
  • people are inherently creative, good and inclined toward competence
  • problems with self-awareness or externally imposed restrictions that can lead to mental health problems
  • Phenomenology: perception is the reality and objective truth is irrelevant
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16
Q

theories of intervention: Carl Rogers - conditions of worth

A
  • other people give conditional love
  • the conflict between sense of self and others’ judgements
  • little emphasis on diagnosis
  • therapist offers unconditional positive regard: empathy and congruence (genuine relationship)
  • clients will figure things out for themselves if they are supported properly
  • focus on present
  • goal: full self-acceptance
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17
Q

theories of intervention: behaviorism

A
  • consistent with empirical/experimental psych roots
  • problems develop through learned associations
    - little albert
    - key is to condition new responses
    - little emphasis on how problems developed
    - formal diagnosis not as important as behavior analysis
  • commonly used for anxiety/behavior problems
  • school interventions
  • goal setting and data collection
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18
Q

theories of intervention: cognitive approaches

A
  • problems develop when thoughts and expectations drive emotions and behavior
  • personal constructs: expectations about the way things will go: social exchanges
  • problems are due to inaccurate or oversimplified personal constructs
  • perception = reality
  • goal: make expectations more rational, logical and flexible
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19
Q

theories of intervention: CBT

A
  • cognitive and behavioral therapies merged in 1960s-70s
  • Ellis: Rational-Emotive Behavior therapy
  • more modern approaches focus on acceptance (ACT)
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20
Q

behavior genetics and neuroscience

A
  • role of medications
  • both therapy and meds change the brain
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21
Q

theories of intervention: systems approaches

A
  • individual behavior is shaped and maintained by larger systems in social context
  • family system
    - tries to maintain homeostasis
    - will push back against change
    - people have prescribed roles
    - boundaries and marital relationships
  • use larger family or group sessions
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22
Q

diathesis-stressor model

A
  • no mental health disorders are 100% heritable
  • stressors may be life experiences but also from broader environment
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23
Q

differential susceptibility model

A
  • gene may seem bad in this environment but if they are placed in a different one they may flourish and do better than without said gene
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24
Q

assessment basic questions

A
  • what is the referral question
  • what does the person want to know
  • Who is the referral source: self, a teacher, parent, court, etc
  • what information do you need to gather
  • what sources of information would you pursue: teachers, parents, bosses
  • how would you arrive at a diagnosis: testing, interview
  • what are your major concerns or risks
    - risks: harm to self or others
    - concerns: dropping out, quitting job
  • what are the person’s strengths
  • do you think the person is a good candidate for treatment
    - What kind of treatment
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25
Q

standardized tests

A
  • how the test is given: specific directions that must be followed
  • how test is scored and interpreted
  • depends on the standardization sample: bell curve, mean and SD
    - if the standard deviation is not representative of the population than it is not reliable
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26
Q

standardized tests: benefits

A
  • reduced interpreter bias
  • helps level the playing field for things like admissions
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27
Q

standardized tests: disadvantages

A
  • even though instructions are the same, sometimes people aren’t able to understand the directions
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28
Q

intelligence testing - types

A
  • Standford-Binet
  • Weschler
  • Nonverbal tests
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29
Q

intelligence tests - verbal/nonverbal

A

what do they measure:
- verbal/nonverbal: intelligence is associated with vocab and verbal ability

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30
Q

intelligence tests - fluid reasoning and crystallized knowledge

A
  • fluid reasoning: ability to solve problems in front of you despite not having outside knowledge
  • crystallized knowledge: stuff you already know, need to have access to education in some form
31
Q

intelligence testing - working memory and processing speed

A
  • working memory: ability to hold info for short period of time
  • processing speed: how quickly can you take info in and spit it back out
32
Q

intelligence tests: advantages

A

helpful for placing people in academic/gifted programs

33
Q

intelligence tests: limitations

A

not a perfect solution for assessing intelligence

34
Q

neuropsychology assessments: who needs them

A
  • geriatric specialization: functioning of elderly people to find signs of cognitive decline
  • traumatic brain injuries
  • neurological conditions
  • children/adolescents
35
Q

neuropsychology assessments: basics of the brain

A
  • development and pruning
  • localization of function
  • lateralization
  • systems and integration
36
Q

neuropsychology assessments: brain damage - occipital lobe

A

visual impairments

37
Q

neuropsychology assessments: brain damage - parietal lobe: hemineglect and simultanagnosia

A

perceptual impairments
- hemineglect = don’t perceive half of what is in front of you
- simultanagnosia = see things but not the full picture

38
Q

neuropsychology assessments: brain damage - temporal lobe: visual agnosia, memory, temporal lobe epilepsy

A
  • visual agnosia: see things but can’t recognize it
  • memory: cannot form new explicit memories
  • temporal lobe epilepsy: see daily events as personally relevant/emotional (paranoia)
39
Q

neuropsychology assessments: brain damage - frontal lobe

A
  • executive functioning: planning, organization
  • personality: no filter
  • impulsivity, perseveration
40
Q

neuropsychology assessments: types of tests

A

Intelligence/cognitive - what you are able to know/learn

Achievement: reading, writing, math - what do you already know

Language - receptive, expressive, pragmatic

Memory - visual, verbal, delayed, immediate, recognition, recall

Attention - impulsivity, distractibility, consistency

Executive functioning - panning, inference, perseveration

Visual-motor

Fine motor

Personality

Emotional/behavioral

41
Q

personality testing: MMPI

A
  • personality and psychopathology
  • empirically derived
  • gave questions to people who were already diagnosed with disorders and analyzed how they answered differently from “normal” people
42
Q

personality testing: NEO-PI3 or MPQ normative personality

A

Big 5, mostly for research

43
Q

personality testing: projectives

A
  • inferences on personality
  • Rorschach: ink blot
  • TAT: storytelling based on a photo
  • sentence completion
  • drawings: useful for kids
  • usually not very reliable or valid
44
Q

psychopathology testing

A
  • depression and anxiety inventories
  • Child Behavior Checklist
  • BASC: assesses positive adaptive skills and disorders, often for parents
  • structured interviews
45
Q

limitations of testing: effort

A

difficulty with children
long and time-consuming

46
Q

limitations of testing: standardization

A
  • sample may not be representative of person
  • if directions are not understood
47
Q

limitations of testing: cultural factors

A
  • bias: access, previous knowledge (school)
  • language
  • communication
  • stereotype threat: if you know there is a stereotype about your identity not doing well on this test, you will score worse
48
Q

clinical interviewing: structured

A
  • usually standardized: same questions, prompts and follow ups
  • may have a decision tree
  • higher reliability
  • ex. SCID
49
Q

clinical interviewing: semi-structured

A
  • set of questions with flexibility for wording or follow-up
  • requires good training because there isn’t very much reliability
50
Q

clinical interviewing: nondrirective/unstructured

A
  • client-led with clinician interjection to gather necessary knowledge
51
Q

clinical judgment vs clinical skill

A

there’s no secret power to know what people have
but clinical skill could be knowing all the diagnose or having the right follow-up questions

52
Q

purpose of interviews: research

A

quantitative: structured to see if people meet the criteria for your study
qualitative: semi-structured

53
Q

purpose of interviews: diagnosis

A
  • structured to make sure important info isn’t missed
  • can be a little semi-structured but not often unstructured
54
Q

purpose of interviews: forensic

A
  • structured to know what you are doing is reliable and valid
55
Q

purpose of interviews: risk determination

A
  • unstructured with interjecting questions can be good depending on the patient
  • but structured can help because it could make the questions seem less important
56
Q

purpose of interviews: part of a larger assessment

A
  • structured battery because it is official for max validity and reliability
  • unstructured can be good for having a convo after a series of other tests
57
Q

purpose of interviews: beginning of therapy process

A

unstructured to build rapport with new patient

58
Q

flow of the interview

A

set up
- what type of contact have you already had
- who made the appointment
opening
- greeting, introduction, rapport
middle
- substance of interview
closing
- keep an eye on the time so you don’t rush the end
- discuss the next steps
- See if they have any questions

59
Q

what must be included in an interview

A
  • introduction
  • confidentiality and limits to confidentiality
    - harm to others or self, children
  • risk assessment
    - how good are clinicians at predicting high-risk events - not very good
    - low base rates
    - Where do you draw the line: over-predictive suicidality or under-predictive
  • Plan for follow-up
60
Q

who will be interviewed

A
  • individual, couple, family, court
  • if a child: who do you see first, parent or child or together
  • adolescent
  • do you choose or should they choose
  • relationship: together, separately
61
Q

what factors influence the interview

A
  • what do you know ahead of time
  • what doesn’t the client know what you know
  • client willingness to participate
  • your goal
  • client’s goal
  • culture
  • client history
62
Q

normal personality differences vs personality disorder

A

impairment = negatively affecting parts of their/ or other people’s lives

63
Q

diagnostic paradox

A
  • both hate diagnoses but want mental health to be taken seriously as a genuine issue
  • don’t like labels and stigma, but want mental health parity laws
  • criticize psychiatric disorders for being too general or changing science but fail to recognize that medical disorders often have the same issues
64
Q

medical model: does the disorder have to reside within the individual

A
  • doesn’t work for PTSD - the person didn’t have it at first and then they experience trauma
  • do mental disorders get cured/go away
65
Q

medical model: impairment criterion

A
  • causes people to wait to get help until they hit rock bottom
  • who decides the impairment
  • wow do you assess impairment
  • some people are high-functioning but that doesn’t mean they are fine
66
Q

if a person had a diagnosis at one time and no diagnosis later does this mean:

A
  • the person never really had the disorder?
  • the person was cured/treated?
  • the person grew out of the disorder?
67
Q

if a diagnosis changes over time:

A
  • is it the same problem, with heterotypic continuity?
  • is it two different points along a pathway?
  • was the first diagnosis wrong?
68
Q

why is comorbidity so common

A
  • chance
  • methodology = how flexible are the diagnoses
  • population under study - children who have been maltreated
  • symptom overlap - depression + anxiety
  • one disorder is an atypical form of another - theory that when boys were depressed they would act out (not a lot of evidence)
  • one disorder causes or leads to another
  • pathways with shared risks/trajectories
69
Q

DSM I/II

A

psychoanalytic orientation
descriptions about how people got disorders

70
Q

changes in the 1970s

A
  • involvement of third-party payers - insurance
    - people would go to therapy 5x a week
  • changes in inpatient programs
    - used to be that people stayed inpatient for months and years and insurance would pay
  • professional competition
    - Clinical practice
  • medications - better meds
  • new treatment models - CBT
  • treating diseases vs life adjustment problems
    - Psychiatry would treat diseases using a clearer DSM
71
Q

DSM III

A
  • developed by a small group of research-focused psychiatrists
  • creation of a categorical diagnostic system following the medical model
  • made causes/pathways irrelevant
  • standardized for research and government programs
  • encouraged the development of medications
  • made diagnosis specialty of psychiatry
72
Q

DSM-5

A
  • removed the multiaxial system from DSM IV
  • Group disorders that have common features
  • Goes in developmental order = neurodevelopmental disorders first
  • Revised some disorders
  • moved things around based on research
  • not longer than DSM-IV
73
Q

categorical system pros

A
  • encourages mental health treatment parity (legitimacy)
  • helps differentiate distinct diagnoses (mood disorder vs thought disorder)
  • improves reliability for research
  • gives common language
74
Q

categorical system cons

A
  • fails to differentiate degree of disorder
  • Fails to consider age, gender, or culture
  • no consideration of pathways, etiology - how people get disorders, at-risk
  • creates confining boxes that fail to capture the diversity of disorder
  • may put disorders in separate categories that belong together
  • no prevention

Clinical Psych (2 decks)

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